San Francisco Likely to Enter Most Restrictive COVID-19 Tier Within Days, Health Officials Warn

Amid a third surge of COVID-19 cases and hospitalizations in San Francisco, the city is likely to move into California's most restrictive reopening tier as early as this week, forcing many business to again close their doors or reduce capacity, and requiring residents to comply with the state's limited stay-at-home order issued last week.

While San Francisco's new infection and hospitalization rates remain lower than in many other areas of California, and well below the state and national average, cases in the city are quickly rising, according to Dr. Grant Colfax, San Francisco's public health director.

"We can see an aggressive increase in our cases week over week," Colfax said at a Tuesday press briefing. "We are fast approaching the case count to be reassigned to the [most restrictive] purple tier ... perhaps later this week."

The city averaged 118 new cases per day over the last week — or nearly 13 daily cases per 100,000 people. That's up from an average of 73 new daily cases at the beginning of the month — a more than 60% increase, Colfax said.

He noted that 54 people in the city were currently hospitalized with the virus, a relatively low number compared to many other jurisdictions in the state, but still twice what it was at the end of October. Since the onset of the pandemic, 14,600 people in San Francisco have been infected with the virus, resulting in 158 deaths, he said.

"We cannot let the virus get so far ahead of us or we will never catch up," Colfax said. "Right now, we still have enough room in our hospitals to care for patients with COVID-19. But, as we have seen across the nation, in the state, and as we saw in our earlier surges, this can change very quickly."

San Francisco, along with two other Bay Area counties, is currently in the second-most-restrictive red tier. If moved by the state into the purple tier, representing the most widespread risk, it would join 45 other counties — including four just added on Tuesday — comprising more than 94% of the state's population.

Similar to the rest of the country,  California is experiencing a surge of cases that threaten to overwhelm hospitals, with daily statewide case numbers setting records on several days recently and hospitalizations up by more than 80% in the last two weeks.

"Statewide, I don’t believe we’ve ever seen as many hospital admissions increase like we did just in the past 24 hours" Dr. Mark Ghaly, the state’s health secretary, said on Tuesday. "I hope, but don’t expect, that it will be the highest that we’ve ever had."

Public health officials are also bracing for a new wave of cases stemming from large Thanksgiving gatherings.

"The fact that we’re in red should give nobody reasons for not taking precautions, particularly around the holiday," said Colfax, who late last week said he expected the city to have already been moved into the purple tier by now.

"We’re hopeful we can crush this third curve, but we do expect nevertheless to be in purple relatively soon."

If that happens, San Francisco would be required within 24 hours to close or reduce the capacity of many nonessential businesses and activities, including shutting down indoor operations at houses of worship, movie theaters and gyms, and reducing capacity to 50% in grocery stores and 25% in clothing and other retails shops. It would also bar most private indoor gatherings with people from different households.

Additionally, San Francisco would also have to adhere to a limited state-imposed stay-at-home order, barring most nonessential work, movement and gatherings between 10 p.m. and 5 a.m., through at least Dec. 21.

Colfax implored San Franciscans to remain vigilant and act responsibly, particularly during the Thanksgiving holiday. He noted there was "robust" COVID-19 testing system across the city, but said testing at city-run sites should be reserved for people with symptoms or exposure, or for essential workers and those without insurance. He also warned that a negative test result represents just one point in time and is "simply not a ticket to freely socialize without precautions."

"This is not the time to throw caution to the wind," he said. "This holiday season indeed will be like no other. And it is so tempting for us to see our loved ones and to gather with our friends. But we simply must stay at home and celebrate Thanksgiving with the people that we already live with."

He called this a "critical moment."

"The choices we make this week will determine what the remainder of the holiday season will look like," Colfax said. "It will determine whether the winter ahead of us will be filled with more hospitalizations, cases and, unfortunately, death, or if we are able to beat back this third surge."